<html>
  <head>
	<title>Metrix | Request Form</title>
	<link href="{{ STATIC_URL }}css/standard.css" rel="stylesheet" type="text/css">
  </head>
  <body>
	<div align="center" class="please">
		Fill out the required information below:
	</div>
	
	<div class="fields">
		{{ problem }}
	</div>
	
	<div class="fields2">
	  <form action="/request/" method="post">{% csrf_token %}
		  {{ form.non_field_errors }}
			<div id="container">		
				<div id="row">
					<div id="left"><label for="id_first_name">First Name:</label></div>
					<div id="middle">{{ form.first_name }}</div>
					<div id="right">{{ form.first_name.errors }}</div>
				</div>
				<div id="row">
					<div id="left"><label for="id_last_name">Last Name:</label></div>
					<div id="middle">{{ form.last_name }}</div>
					<div id="right">{{ form.last_name.errors }}</div>
				</div>
				<div id="row">
					<div id="left"><label for="id_email">Email:</label></div>
					<div id="middle">{{ form.email }}</div>
					<div id="right">{{ form.email.errors }}</div>
				</div>
				<div id="row">
					<div id="left"><label for="id_password">Password:</label></div>
					<div id="middle">{{ form.password }}</div>
					<div id="right">{{ form.password.errors }}</div>
				</div>
				<div id="row">
					<div id="left"><label for="id_confirm_password">Confirm Password:</label></div>
					<div id="middle">{{ form.confirm_password }}</div>
					<div id="right">{{ form.confirm_password.errors }}</div>
				</div>
			</div>		
		  <div id="submit">
	        <input type="submit" value="Send" />
		  </div>
	  </form>
  	</div>
  </body>
</html>